This article discusses recent developments in and new principles of European social health insurance (SHI). It analyses how privatization policies and competition have altered social insurance and whether financial difficulties are caused by social insurance features not evident in other types of health care systems. There is little if any evidence that SHI causes higher cost increases than other types of systems. The comparison of five European SHI systems demonstrates that despite cost containment policies these countries do not experience a trust crisis in health care or loss in support among the public. The author shows that SHI has moved toward universal health care and that the traditional values of solidarity and social security have even been strengthened over the past decades.

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